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This paper presents the author's theoretical approach to the treatment of seriously disturbed patients, an approach that goes beyond many traditional beliefs and practices within psychoanalysis. Working analytically with such patients requires us to move far beyond the work of interpreting unconscious motivations. The author presents a case illustrating the central importance of what she refers to as “at-one-ment” and “withnessing,” both of which presuppose an approach based on the ontological dimension of human experience and not on the epistemological focus of interpretation.